Information Collection

Instrument 5: Home Visitor and Other Staff Interview Protocol

IC 270763 under ICR 202409-0970-002 · OMB 0970-0638.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0638 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 5_Home Visitor and Other Staff Interview.docx	Other-Interview
Instrument 5_Home Visitor and Other Staff Interview.docx	Other-Interview

IC Title:

Instrument 5: Home Visitor and Other Staff Interview Protocol

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview			Instrument 5_Home Visitor and Other Staff Interview.docx		Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 42

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	42	42
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.